Archive | June 2010

Lung Assessment

 

Adventitious or abnormal sounds

  • rales
  • rhonchi
  • friction rubs
  • distinguish these from friction sounds of the stethoscope on the chest wall and by muscular activity within the chest wall

 

Breath sounds are decreased or absent when air flow is decreased eg. Bronchial obstruction, muscular weakness or pulmonary empyema, in which there is an abnormally large amount of air that damps the sound.

Additionally, breath sounds may be decreased when fluid or tissue separates the air passages from the stethoscope (obesity or pleural disease). As vibrations may be partially reflected at air-fluid or dense tissue interfaces.

The commonest cause of abnormal bronchial breathing is consolidation of the lung. When consolidation occurs, damping action of air-containing alveoli of diminished, allowing underlying higher frequency bronchial sounds to be heard without alteration.

If breath sounds are diminished or if you suspect but cannot hear signs of abstructive breathing, ask the patient to breathe hard and fast with his mouth open. The diminished breath sounds associated with obesity may become readily audible, wheezes and ronchi that were previously inaudible may appear.

Breath sounds remain decreased in emphysema. Wheezes or rhonchi may appear in emphysema, asthma or bronchitis.

 

Bates, Barbara. 1974. A Guide to Physical Examination. J.B. Lippincott Company, Toronto.

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Cardiomyopathy

diminished contractile function of the muscle fibers and diffuse necrosis of myocardial cells.

Results: poor systolic function.

Structural changes of the heart muscle decrease the amount of blood ejected from the ventricles after contraction.

Less blood is able to enter the ventricles during diastole, increasing en-diastole pressure and eventually increasing pulmonary and systemic venous pressures.

Implications:

Altered valve function, regurgitation, may result due to overstretched ventricles.

Poor blood flow through the ventricle may also cause ventricular or atrial thrombi resulting in emboli travelling to other part of the body.

Manifestations:

Condition may remain stable and asymptomatic for years.

  1. Dyspnea on exertion
  2. Low endurance – fatigue
  3. Cough
  4. Orthopnea
  5. edema
  6. nausea
  7. chest pain
  8. palpitations
  9. syncope on exertion

Physical Examination:

  1. Auscultation
  2. tachycardia
  3. S3 and S4
  4. diastolic murmur
  5. crackles on pulmonary auscultation
  6. jugular vein distension on palpitation and inspection
  7. pitting edema of extremities on inspection and palpitation
  8. hepatomegaly on palpitation

Diagnosis:

  • patient history
  • elimination of other heart failure etiology
  • echocardiogram – allows view of heart structure and ventricles
  • chest X-ray – illustrate presence of cardiomegaly and pulmonary congestion if present
  • Cardiac catheterization – eliminate possible coronary artery disease
  • endomyocardial biopsy – for cardiocellular analysis

Day et al. 2010. Textbook of Canadian Medical-Surgical Nursing. 2nd ed. Lippincott, Williams and Wilkins. Philadelphia.

Lung Cancer Staging

Stage Description
Occult carcinoma Cancer cells are found in the sputum coughed up from the lungs, but a tumour cannot be seen in the lung.
0 Abnormal cells are found in the lining of the lung or of the air passages (trachea, bronchi or bronchioles). Abnormal cells have not spread to the tissues of the lung itself, but the cells may become cancerous and then spread. Stage 0 is also called carcinoma in situ.
1 Stage 1A: The tumour is in the lung only and is less than 3 cm in size.

Stage 1B: The tumour is larger than 3 cm or it is growing into the main airway of the lung (bronchus). It may also have spread to the covering of the lung (pleura) or made the lung partially collapse.

2 Stage 2A: The tumour is less than 3 cm but has spread to nearby lymph nodes.

Stage 2B: The tumour is larger than 3 cm and has spread to nearby lymph nodes.

OR The tumour has grown into the chest wall, the pleura, the muscle layer below the lungs or the covering of the heart.

OR The tumour has made the lung collapse.

3 Stage 3A: The tumour can be any size. Cancer cells have spread into the lymph nodes in the middle of the chest (mediastinum) but not to the other side of the chest.

OR The cancer has spread to the tissue around the lung near where the cancer started, such as into the chest wall, the pleura, the middle of the chest or nearby lymph nodes.

Stage 3B: There are 2 or more tumours in the same lung.

OR Cancer cells have spread to lymph nodes on the other side of the chest or to nodes above either collarbone.

OR The cancer has spread into another major structure, such as the esophagus, the heart, the trachea or a main blood vessel.

OR Cancer cells are found in the pleural fluid (called pleural effusion).

·                       

4 Cancer has spread to other parts of the body, such as the liver, brain or bones.

 

Canadian Cancer Society.

The Palliative Performance Scale (pps)

Victoria Hospice Society. Canada.

Filtration angle

 A narrow recess between the sclerocorneal junction and the attached margin of the iris, at the periphery of the anterior chamber of the eye; it is the principal exit site for the aqueous fluid.

Aortic Atresia

With this condition, there is no opening, or a very small opening, from the left ventricle into the aorta. “Atresia” refers to a missing heart structure.

The valve cannot open properly, which means the blood can’t move from the left ventricle to the body. The only source of blood flow to the body will be through the ductus ateriosus.

Aortic atresia usually occurs in combination with other heart defects, typically hypoplastic left heart syndrome.

6 indicated the location of the aorta and purple indicates the resulting implications of imparied oxygenation through the heart.

10th Cranial Nerve Paralysis

Etiology

Vagus nerve pathway is affected. eg by tumor or aneurysm.

Vagus nerve:

Supplies nerve fibers to the pharynx, larynx, trachea, lungs, heart, esophagus and the intestinal tract as far as the transverse colon.

The vagus nerve brings sensory information back from the ear, tongue, pharynx and larynx.

Manifestation:

 When pt says “Ah” the soft palate on the paralyzed side fails to rise. The uvula deviates tot he uninvolved side.